Flex Your Alternatives. Control costs and care with Consumer Driven Health Care.

Benefits Summary

AmeriHealth® PPO

Receive care from any provider without a referral in network or non-network. Some services may require preauthorization.

Benefits AmeriHealth PPO 5 AmeriHealth PPO 10/20/70 AmeriHealth PPO 1020/80/50
  Network Non-Network Network Non-Network Network Non-Network
Deductible (Individual/Family) NONE $250/$500 NONE $300/$600 $1,000/$2,000 (Network/Non-Network combined)
After Deductible, Plan Pays 100% 80% 100% 70% 80% 50%
Out-of-Pocket (Individual/Family) NONE $1,000/$2,000 NONE $2,000/$4,000 $4,000/$8,000 $10,000/$20,000
Overall Lifetime Maximum Unlimited $5 Million Unlimited $5 Million Unlimited $5 Million
Primary Care Provider Office Visit $5 80% $10 70% $20 50%
Specialist Office Visit $5 80% $20 70% $30 50%
Inpatient Hospital Care 100% 80% $75 per day, $375 per adm 70% 80% 50%
Lab 100% 80% 100% 70% 100% 50%
Preventive Care Office Visits $5 80% $10 70% $20 50%
Routine GYN Exam/Pap Smear 100% 80% 100% 70% 100% 50%
Maternity Care: First OB Visit $5 (100% thereafter) 80% $10 (100% thereafter) 70% $20 (100% thereafter) 50%
Maternity Care:
Inpatient Hospital		 100% 80% $75 per day, $375 per adm 70% 80% 50%
Emergency Care $25 (waived if admitted) $25 (waived if admitted) $40 (waived if admitted) $40 (waived if admitted) 80% (not waived if admitted) 80% (not waived if admitted)

The above table illustrates some of the benefit programs available. This managed care plan may not cover all your health care expenses. This information has been extracted from and is subject to the terms and conditions of all applicable group contracts and member handbooks.